Journal of clinical anesthesia
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Headache is a common finding in the postpartum period. A wide variety of factors can contribute for its appearance and the causes include primary as well as secondary headache disorders. ⋯ We describe a patient with a headache in the immediate postpartum period. It was initially diagnosed as a common postdural puncture headache, but was later discovered to be a cervical hematoma.
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Due to excessive sugammadex expenditures at our institution, we designed dosing guidelines that utilize adjusted body weight and informatics-based tools aimed at reducing variability in dosing practices. ⋯ Provider education and digital quality improvement was associated with reduced rates of high-dose sugammadex administration, generating cost savings at a large academic medical institution.
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Case Reports
A complication of ECMO cannula placement resulting in hemodynamic and oxygenation alterations: A case report.
Veno-veno extracorporeal membrane oxygenation (VV ECMO) is used as a bridge to recovery in acute respiratory distress syndrome (ARDS) patients who have reversible lung failure. We present a complication of ECMO cannula placement/position resulting in hemodynamic and oxygenation alterations. These demonstrate principles related to the interaction of the VV ECMO circuit and patient cardio-pulmonary physiology. Consideration and comprehension of pulmonary shunt fraction, ECMO cannula recirculation ratio and ECMO blood flow to cardiac output (CO) ratio are central to continuous assessment and diagnosis of cardio-pulmonary changes encountered during management of VV ECMO.